Antonella Meloni1, Gennaro Restaino2, Zelia Borsellino3, Vincenzo Caruso4, Anna Spasiano5, Angelo Zuccarelli6, Gianluca Valeri7, Patrizia Toia8, Cristina Salvatori1, Vincenzo Positano1, Massimo Midiri8, Alessia Pepe9. 1. CMR Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy. 2. Radiology Department, "John Paul II" Catholic University, Campobasso, Italy. 3. Ematologia-Emoglobinopatie, Civico Hospital-ARNAS, Palermo, Italy. 4. Centro Microcitemia, "Garibaldi" Hospital, Catania, Italy. 5. Centro per la Cura delle Microcitemie, Cardarelli Hospital, Napoli, Italy. 6. Centro trasfusionale, Osp. Giovanni Paolo II, Olbia, Italy. 7. Radiology Department, University of Ancona, Ancona, Italy. 8. Istituto di Radiologia, Policlinico "Paolo Giaccone", Palermo, Italy. 9. CMR Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy. Electronic address: alessia.pepe@ftgm.it.
Abstract
BACKGROUND: The multislice multiecho T2* cardiovascular magnetic resonance (CMR) technique allows to detect different patterns of myocardial iron overload (MIO). The aim of this cross-sectional study was to verify the association between cardiac complications (heart failure and arrhythmias), biventricular dysfunction and myocardial fibrosis with different patterns of MIO in thalassemia major (TM) patients. METHODS: We considered 812 TM patients enrolled in the Myocardial Iron Overload in Thalassemia (MIOT) Network. The T2* value in all the 16 cardiac segments was evaluated. RESULTS: We identified 4 groups of patients: 138 with homogeneous MIO (all segments with T2* < 20 ms), 97 with heterogeneous MIO (some segments with T2* < 20 ms, others with T2* ≥ 20 ms) and significant global heart iron (global heart T2* < 20 ms), 238 with heterogeneous MIO and no significant global heart iron, and 339 with no MIO (all segments with T2* ≥ 20 ms). Compared to patients with no MIO, patients with homogeneous MIO were more likely to have cardiac complications (odds ratio-OR = 2.67), heart failure (OR = 2.54), LV dysfunction (OR = 5.59), and RV dysfunction (OR = 2.26); patients with heterogeneous MIO and significant global heart iron were more likely to have heart failure (OR = 2.38) and LV dysfunction (OR = 2.39). CONCLUSIONS: Cardiac complications, heart failure and dysfunction were correlated with MIO distribution with an increasing risk from the TM patients with no MIO to those with homogeneous MIO. Using a segmental approach, early iron deposit or homogeneous MIO patterns can be characterized to better tailor chelation therapy.
BACKGROUND: The multislice multiecho T2* cardiovascular magnetic resonance (CMR) technique allows to detect different patterns of myocardial iron overload (MIO). The aim of this cross-sectional study was to verify the association between cardiac complications (heart failure and arrhythmias), biventricular dysfunction and myocardial fibrosis with different patterns of MIO in thalassemia major (TM) patients. METHODS: We considered 812 TM patients enrolled in the Myocardial Iron Overload in Thalassemia (MIOT) Network. The T2* value in all the 16 cardiac segments was evaluated. RESULTS: We identified 4 groups of patients: 138 with homogeneous MIO (all segments with T2* < 20 ms), 97 with heterogeneous MIO (some segments with T2* < 20 ms, others with T2* ≥ 20 ms) and significant global heart iron (global heart T2* < 20 ms), 238 with heterogeneous MIO and no significant global heart iron, and 339 with no MIO (all segments with T2* ≥ 20 ms). Compared to patients with no MIO, patients with homogeneous MIO were more likely to have cardiac complications (odds ratio-OR = 2.67), heart failure (OR = 2.54), LV dysfunction (OR = 5.59), and RV dysfunction (OR = 2.26); patients with heterogeneous MIO and significant global heart iron were more likely to have heart failure (OR = 2.38) and LV dysfunction (OR = 2.39). CONCLUSIONS:Cardiac complications, heart failure and dysfunction were correlated with MIO distribution with an increasing risk from the TM patients with no MIO to those with homogeneous MIO. Using a segmental approach, early iron deposit or homogeneous MIO patterns can be characterized to better tailor chelation therapy.
Authors: Pandji Triadyaksa; Niek H J Prakken; Jelle Overbosch; Robin B Peters; J Martijn van Swieten; Matthijs Oudkerk; Paul E Sijens Journal: MAGMA Date: 2016-12-16 Impact factor: 2.310
Authors: Pandji Triadyaksa; Astri Handayani; Hildebrand Dijkstra; Kadek Y E Aryanto; Gert Jan Pelgrim; Xueqian Xie; Tineke P Willems; Niek H J Prakken; Matthijs Oudkerk; Paul E Sijens Journal: MAGMA Date: 2015-11-03 Impact factor: 2.310
Authors: G J H Snel; M van den Boomen; L M Hernandez; C T Nguyen; D E Sosnovik; B K Velthuis; R H J A Slart; R J H Borra; N H J Prakken Journal: J Cardiovasc Magn Reson Date: 2020-05-11 Impact factor: 5.364